Revolutionizing Diebates Care with Technology

TRANSCRIPT 

Bryce

Welcome to Digital Health Transformers, a podcast series. In this podcast, we’ll explore the dynamic world of healthcare innovation one conversation at a time. I’m your host, Bryce Barger, and today we have an awe-inspiring guest at the forefront of transforming the digital healthcare landscape.

I’ve always been intrigued by technology and diabetes prevention. As some of you might know, in past episodes, I’m a type 1 diabetic myself, and today I’m more than pleased to welcome our guest, Lawrence Gerrard, who is the CEO and founder of the company FruitStreet. Girard is a prominent voice in digital health, precisely telehealth, and founded FruitStreet with a vision of promoting a healthier lifestyle.

Gerrard is an alumni of Harvard Business School, having completed the PLD 36, and is a current Sloan Fellow at London’s Business School. FruitStreet is an online telehealth and wellness platform that helps people achieve a healthy lifestyle. The primary vision of FruitStreet is the CDC’s diabetes prevention program.

In this episode, we’ll discuss more about Lawrence Gerrard, FruitStreet’s journey, and to take on his preventative technologies, digital health, and diabetes care. Thank you for joining us today, Lawrence. How are you?

Laurence

Good. Thanks for having me on the show, Bryce.

Bryce

I really appreciate what you’re doing with the podcast. Yes, that was awesome. I really appreciate you taking the time to join us.

So, Lawrence, kind of getting started, how did your journey in healthcare, in the healthcare industry, in the diabetes world kind of start?

Laurence

Yeah, so when I was 18, I thought about what I wanted to do for a career, and I decided that I wanted to go to medical school. So I started volunteering in my local emergency room, and was simultaneously taking a nutrition epidemiology course with a Harvard School of Public Health professor. And then I realized that a lot of the patients that were coming into the emergency room had preventable conditions related to their diet and lifestyle.

They had conditions like diabetes, heart disease, stroke, obesity. And I just thought that we could do more on the prevention side. And that’s kind of where the idea of Fruit Street started, this idea of prevention through telehealth.

I had also become quite interested in telehealth because I was volunteering for an education nonprofit that provided free online tutoring through video conferencing for K through 12 students. So I started to think about applying video conferencing to healthcare, which really makes these types of interventions accessible to people regardless of where they are. And then I kind of kept going down the medical school route for a while.

I moved to Boston, and I was in the bachelor’s degree program at the Harvard Extension School. And I became interested in entrepreneurship because the first year I was there, they opened the Harvard Innovation Lab on the business school campus, which kind of opened my eyes up to entrepreneurship. And I started to think that maybe I could have a big impact in public health through technology and entrepreneurship.

So I started Fruit Street as a summer project about 10 years ago. And then I learned about this research that had been conducted around the diabetes prevention program. And we decided to digitize the program to make a very long story of 10 years short.

But really, I think that as a country, we can do a lot more to prevent lifestyle-related conditions through technology.

Bryce

And of course, obviously, everyone knows how rampant diabetes is in America. Is there a reason that Fruit Street really is focusing on diabetic care?

Laurence

Yeah, so I would say that if you think about chronic diseases, a lot of it starts with diabetes. So if someone gets type 2 diabetes, it can lead to stroke, amputation, blindness, you know, dialysis, and other issues if it’s not managed well. And even though the program’s called the Diabetes Prevention Program, it’s really more of a, like, cardiometabolic kind of like risk reduction program, where a simple way of putting it would be just living a healthier lifestyle, right?

So the curriculum covers topics like diet, exercise, sleep, stress management, encourages achieving 150 minutes of moderate physical activity per week. Participants are encouraged to, you know, lose 5% of their weight, eat more fruits and vegetables. And so it really will help you to reduce your risk for heart disease, other weight-related issues.

We see a lot of people improve their blood pressure. But the whole history of this specific program goes back to a Medicare-funded clinical trial that was conducted about 20 years ago, where Medicare spent about $175 million, and they enrolled about 3,000 patients with prediabetes, which just means they have elevated blood glucose, and they have a high risk for developing type 2 diabetes. And what they did was they compared a placebo to metformin, the pharmaceutical drug, to this lifestyle modification program, and they found that the lifestyle program was more effective than metformin in preventing type 2 diabetes.

The lifestyle group reduced their risk by 58%, and in people over 60, they reduced their risk by 71%. So that was published in the New England Journal of Medicine and led to Medicare and Medicaid paying for the program, as well as employers and health plans. And then the CDC built a national public health program where there’s now 1,600 organizations delivering this program.

I think also, like, the healthcare payers really like to hear the word diabetes prevention, because they know diabetes costs so much money for them. But really, this is a program that will make people healthier overall and reduce your risk for many different chronic diseases.

Bryce

Not just diabetes, it’s really an overall. I love that. Yeah.

Okay. So kind of getting into that preventative care and that chronic care management, the rate of chronic conditions is obviously steadily increasing. Really, healthcare experts have often highlighted preventative care.

What is your take on really the steady increase in chronic conditions in this country?

Laurence

Yeah. I mean, I think that it has a lot to do with our food system, really, and the culture around food. I mean, we’re doing things like subsidizing corn, which leads to corn syrup, instead of fruits and vegetables.

We also have food deserts in many areas of the country where healthy food is not accessible. But we could also probably do more to teach children how to cook and that kind of thing from a young age. It’s not just about promoting physical activity.

You have to know how to cook a healthy meal for yourself, and it has to be affordable. So I think a lot of it has to do with those types of issues. And it seems that the whole country is, well, not the whole country, but a large portion of the country has turned to drugs like Ozempic, which seem to be effective in the short run.

I don’t know if we know what their long-term consequences are, if it’s really sustainable in the long run. You have a lot of healthcare payers that don’t want to pay for Ozempic because of how expensive it is. We’re trying to take a different approach where we recently discovered that the Affordable Care Act requires insurance companies to essentially pay for services like medical and nutrition therapy.

And so there’s now startups, including Fruit Street now, that are going to be delivering telehealth sessions with the dieticians that are paid for by the majority of commercial health plans. So like UnitedHealthcare, Anthem, Aetna, Cigna, which means that a startup like Fruit Street could market to a consumer and they could take out their insurance card and it would be free to them, usually with zero copay. So that’s something that we’re launching.

And I think that even though there’s probably 1 to 200 million people covered with that benefit, they just don’t know that they have that coverage where they can meet with a dietician. But I think that if we could get more preventive services out there and make people aware that they have access to a dietician instead of just going for the Ozempic route, I think that it would go a long way. It’s not to say that Ozempic is not a good drug.

I mean, I think it’s very helpful for some people, but I think ideally they would also be working with a virtual dietician so they can make long-term lifestyle changes as well. Yeah.

Bryce

And instead of seeing Ozempic turn into this, what I think is, my wife’s a pharmacist and sees Ozempic a lot, and we’ve talked about it. I’m like, oh, what is this new drug? It’s Ozempic.

And she said, well, it’s almost becoming the new weight loss Adderall, where it’s becoming almost like abused in a way, instead of, or maybe just a immediate results type of drug, instead of teaching them the sustainable ways to a healthy lifestyle, healthy diet, to where they don’t always have to use Ozempic for the rest of their life, or there isn’t a need for that. They can learn how to actually change their lifestyle themselves instead of using a managed drug. So I really, really love that.

Moving on into diabetes care in the next few years, obviously the technologies in diabetes care and diabetes management is really increasing with your continuous glucose monitors, your insulin pumps. Where do you see Fruit Street and diabetes management technology in the next few years? And what do you see your impact on that?

Laurence

Well, I think that the insurance companies are going to pay for food as medicine. So something very simple, but they are doing that already. And I think that often in US healthcare, we’re always looking for the magic device or the magic pill, right?

But what about the magic, healthy food that can be delivered to people and really have a medical effect on them? So we have one partner called Modify Health that’s medically tailored meals to people and Medicaid programs now that pay for that. And so I think that we need to recognize food as medicine, as like the innovation, rather than everything having to be an FDA approved medical device.

I mean, with that being said, I think a lot of people get value from continuous glucose monitors for sure. But what if they could also have healthy foods so they can see their numbers improve, right? Because ultimately you need to have healthy food if you’re going to improve numbers as well.

Bryce

Yeah, just using a CGM is not going to overall, I mean, you might tell you what your blood sugar is, but it’s not going to help you lower or help you control it any more than what you intake into your body. So that’s 100% true. And that was one reason why I love for the education aspect that you guys are pushing is so it might not be the shiny pretty Ozempic, but it’s truly the way forward and the correct way forward.

So I do love that. Moving on into telehealth and kind of its impact on chronic care as fruit street is offering telehealth for managing diabetes care. And what challenges do these technologies like telehealth and RPM kind of have in managing chronic conditions?

Are there any challenges that you guys face with telehealth and remote patient monitoring?

Laurence

I think the biggest challenge is reimbursement, which is becoming less of a challenge. I mean, we started out by selling fruit street as a benefit to self-insured employers and health plans. And we went through these like multi-year sales cycles that were, you know, pretty, pretty long.

And then you just question, like, why am I talking to a benefits manager about medical science? I mean, they didn’t go to medical school. Right.

And so I’d say like our recent discovery that the Affordable Care Act requires coverage for certain services like medical nutrition therapies, pretty profound if you think about it, because now a digital health startup doesn’t have to go through a self-insured employer or benefits manager. You can just contract with an in-network. I mean, with a health plan to become an in-network provider, all the health plans that a doctor would contract with United, Anthem, Sigma, Aetna, and so forth, which means you can then market to a consumer and it’s completely free to them.

I mean, you have Americans paying so much on a monthly basis for health insurance. So then to ask them to pay for another digital health service out of pocket doesn’t really make sense because they’re already paying so much money for health insurance. So I think ultimately, you know, coverage is the thing that telehealth companies have struggled with.

I think before the pandemic, they’ve struggled with, you know, some people had not experienced telehealth before, but now most people have because of the pandemic. So that’s no longer an issue, but definitely the reimbursement has been the historical challenge.

Bryce

Trying to get the old guard to change is always interesting, especially. And I wonder without 2020 and the pandemic, how long it would have taken us to finally get to something so great, which telehealth is almost seems like a no-brainer, that it’s so crazy that it took us a pandemic to realize the benefits of it. We’ll never wait for crisis, they say.

Yeah, it’s true. That’s very true. So with the recent surge in AI, everyone, I know AI is a hot topic in healthcare, especially.

Do you see, do you kind of, or can you think of maybe some ways that AI can positively impact chronic care management?

Laurence

Yeah. I mean, for example, people have been trying to figure out for the last 10 years or longer, how to take a picture of your food and, you know, basically figure out how many calories it has or figure out if it’s healthy or not. And so this past Thanksgiving, I said, let me see how the chat GPT app does.

So I took a picture of the entire Thanksgiving table and pretty much identified everything on the table, turkey, green beans, sweet potato, and told me if it was healthy. And I don’t think that replaces a dietician necessarily, because I think the dieticians that work for first street facilitate these really supportive group visits where you have the sense of community and human connection. But I think in terms of when someone’s logging, you know, their food, if they can get instant feedback from AI their, their behavior is going to change quicker, right?

Because if you get a feedback, you know, a week later from a dietician, I mean, you’re not getting that immediate effect of, okay, I took a picture and I got feedback instantly, right. Versus getting that feedback later. And I think most of our dieticians, you know, prefer the human interaction component of this.

You know, they don’t need to necessarily tell you that, you know, an apple is healthy or, you know, that you maybe could have made a better choice than a candy bar constantly. Right. I think like they enjoy the human component of, Hey, we’re on a zoom.

We’re facilitating a group class. They’re doing motivational interviewing. And so I think that the AI component can take out some of the monotonous work that a lot of dietitians see of having to comment on like thousands and thousands and thousands of pictures of food and just let them focus on the live telehealth visit.

Yeah. Yeah. Yeah.

No. I was going to say one more thing. Like also like, I think AI is great.

If you want to come up with like a quick recipe. So if you said like, I don’t know, I have eggs, tomatoes in the house. Like what can I make with this right now?

Bryce

Pretty much get an instant response. Yeah. Yeah.

I love that actually. That’s, I did not think of that. That’s actually really, it’s actually really, really smart.

Moving into kind of the preventative technologies and it’s the impact on patient care. What is your opinion on preventative technologies being crucial in managing chronic conditions and, and kind of, and what, what preventative technologies can make a difference?

Laurence

Yeah. Well, I think there’s like monitoring technologies where, yeah, this is a futuristic way of looking at it. I’m not sure if we’ll ever get here, but like, you know, it’s like the smart toilet bowl or something like that.

Right. Or maybe a simpler version would be like, just like a wireless scale, which seems like something simple or the blood pressure cuff that you have at your home, like your Whittings blood pressure cuff. Right.

I think part of it is you used to have all these devices, like a scale, a blood pressure cuff, even like, you know, continuous glucose monitors where these things weren’t available in people’s homes, like a hundred years ago necessarily. Right. But now they’ve become so cheap and also connected through technology where they are.

And that means that you can detect things early. I mean, there’s even been stories of people wearing like an Apple watch or a Fitbit that have found an underlying heart condition. So I think, you know, you can identify things earlier, but then there’s also things that can, you know, change behavior, like the ability to do telehealth with a dietitian.

Well, now you don’t have to drive three hours to see a dietitian. So the telehealth component of it could be the difference between someone seeing a dietitian or not. Right.

Yeah. Yeah. So I think some of it is like, you know, taking regular measurements, like blood pressure or weight.

And then the other part is like, how do you use technology to change someone’s behavior? Because ultimately most of the chronic diseases that we experienced are related to, you know, some sort of dial and lifestyle. I mean, it’s not always the case, but if you look at the big ones, right, like type two diabetes, heart disease, stroke, obesity, a lot of it can be impacted through lifestyle changes, lifestyle changes for sure.

Bryce

Yeah. Yeah. So kind of wrapping up here and Lawrence, I really appreciate your, your, your insight on this.

And again, as kind of as a somebody who deals with not necessarily with type two diabetes in the same aspect, but dealing with this world and seeing companies like Fruit Street continue to innovate and continue to push the boundaries forward and to continue to do it the right way. And again, this is not, not a knock on his epic, but, but really teaching people the right way to change their, their, their lifestyles and to make healthy changes is so important and such a needed, a needed resource in this country, and especially in the diabetes lifestyle. So thank you so much for that in the future.

And do you think kind of preventative technologies can help physicians make timely intervenes for diseases like, like, like cancers and, or, or diabetes and like, kind of, as you mentioned with the Apple watch, is there a way where you could find underlying, maybe an underlying illness? Is there, what kind of, how do you, how do you see the future preventative technologies kind of going?

Laurence

Yeah. I mean, I think some of it is not even patient facing. I heard one news article where they’re using AI to analyze electronic medical record data and they were able to identify, I think there was certain rare patterns or yeah.

Bryce

Yeah.

Laurence

A physician may not notice something, but if you look at used AI on like a population level, I actually discover something. I think it’s also people working on like new blood tests as well for certain cancers where we might be able to detect them, you know, more early as well. I mean, and usually I think it’s cheaper to catch something early than later.

And you’re also of course going to save lives by doing that. So I think a lot of healthcare innovations are going towards how do we detect something early so that it’s, you know, we have a higher chance of saving someone’s life or extending their life. But also it’s more cost effective for the healthcare system.

So I think you see that with like, you know, blood tests, you see that with like AI looking at EMR data. You’re also seeing it with like the at home devices that we discuss already as well. So yeah, definitely there’s been a lot of focus on prevention recently.

Bryce

Any kind of emerging preventative technologies that FreeTree can share with us that aren’t being kept too close to the chest, which I understand that are coming maybe in the next few years here?

Laurence

You know, the beautiful thing about diet and lifestyle changes, or I guess the blessing and the curse is that it’s so simple that it’s not a secret, right? But you know, we don’t have any like super fancy patents or anything like that, or top secret technology. I think what we’re trying to do is really to say, look, I mean, we know how to prevent chronic diseases that are the leading causes of death, heart disease, smoking, you know, type 2 diabetes, stroke, right?

Which is why it’s so simple, but powerful. I heard one physician say once that, you know, if you could take like the health benefits of exercise and patent it and put it in a drug, it would be like a blockbuster drug and you’d want to buy stock tomorrow. But yeah, it’s just not the case.

I don’t know how far along this technology is, but I know a lot of people are trying to work on taking the technology of CGMs and putting it into like a Fitbit or an Apple Watch or like a little, a smaller, you know, patch. I mean, I’ve never tried it for myself, but I know some people are using CGMs, even if they’re not diabetic, just to like see the effect that, you know, food has on their blood sugar. I suppose, I imagine it would have an effect on, you know, changing your behavior, where maybe you would think twice about having, you know, a soda or a candy bar.

So if they could, if they could make that technology cheaper and embed it into devices like Fitbit or Apple Watch, I think it’d be quite popular, but I’m not the, I don’t know, mechanical or physical engineer here. So I don’t know if that’s possible, but I know some people have tried to work on things like that.

Bryce

Yeah, I know. It’s a very interesting, I found with my CGM recently is, I’m a big, I love pizza, like most of, like most Americans do, but pizza’s definitely one of my guilty pleasures. And, but when I eat, I can obviously, and type 1 diabetes is different than type 2, as everybody knows, but if I can give myself insulin and I can have a couple slices of pizza and I’m assuming, I was told by my endocrinologist that it’s normally the fat content in pizza, but it will automatically, I can give myself the right amount of insulin, it will shoot my sugar high and will hold me for an extended period of time. And it’s so interesting that I can see it on my CGM now because it tests your blood sugar every, every five minutes and gives you that, that thing. And you can, you can see where it’s like, wow, giving myself insulin, I should not be doing this, but you, and you see, you almost see the damage happening as your sugar rides at 300 or right, right at whatever, whatever that might be.

So that would be very interesting to see what that looks like in somebody who, who maybe has pre-diabetes or like you’re mentioning and is dealing with some preventative medicines and some preventative care like that. So I really love that. Lawrence, thank you so much for your time and sharing your valuable insights on preventative care and technologies and preventative care and chronic care management.

I really enjoyed our conversation. Thank you so much again for your time. I hope this will help our viewers kind of open their eyes to some, to maybe a different side of where it’s not, it’s doesn’t always need to be Euro sound pics.

It can be your education and your lifestyle changes as well. So thank you so much. Yeah.

Thanks for having me on the show. Thanks. Talk to you soon.

Cool. Thank you so much, Lawrence. I really appreciate that.

Laurence

Great. Yeah. Thanks for accommodating Sunday.

I appreciate that.